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The International League Against Epilepsy (ILAE) task force on neonatal seizures has recently published draft guidelines and consensusbased recommendations on the treatment of neonatal seizures. This update provides a summary of the recommendations and the changes in management compared to the previous WHO ILAE guidelines, published in 2011, with emphasis on practical decision making requirements for a pediatrician.
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Pleomorphic adenoma is the most common salivary gland tumor accounting for 80% of all major salivary gland tumors. It is a benign salivary gland neoplasm that constitutes 3% to 10% of the neoplasms in the head and neck region.1 Salivary gland neoplasms represents less than 1% of all tumors. This article is being showcased as a special case due to the fact it was done at a Taluk Hospital and also because ENT and oromaxillofacial surgeons were involved during the surgery.
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The case describes the anatomy and pathophysiology of the palatine tonsils and the development of intratonsillar abscess. The abscess can be caused by a suppurative focus that arises in acute tonsillitis when outward drainage is prevented, leading to pus accumulation in the tonsillar tissue. Dehydration or a history of peritonsillar abscess can also lead to intratonsillar abscess. The condition can be mistaken for tonsillolith or malignancy, such as lymphoma. A computed tomography (CT) scan is recommended for diagnosis, showing a low-density and ring enhancement. Aspiration using a large bore needle is the preferred mode of treatment, but if repeated aspirations fail, tonsillectomy may be necessary. Intratonsillar abscess is rare and so far only 29 cases have been reported.1 The differential diagnoses include lymphoma, which usually presents as unilateral enlargement of the tonsil, tonsillolith due to its appearance and peritonsillar abscess again due to the unilateral enlargement of the tonsil. This case is different as compared to other reported cases we did not do a CT scan as recommended by most of the studies (cost being a concern). Also, in this case, we resorted to surgery as the main modality unlike other cases wherein the surgeons opted to do an aspiration of the pus mainly keeping the intraoperative complications in mind.
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Introduction: Indians are experiencing nutritional and lifestyle transitions due to globalization and westernization. The study aimed to find out the current eating patterns and body shape concerns and various factors that influence eating behaviors and body shape concerns of late-adolescent girls. Material and Methods: A cross-sectional study was conducted among 230 undergraduate adolescent girl university students from 12 departments in the age group of 17–19 years. Eating attitude and body shape concerns of adolescents were determined by using the standard eating attitude test-26 (EAT-26) and body shape questionnaire (BSQ-34). Results: The duration of the study was 6 months and participants were selected by simple random sampling. The mean age of the study subjects was 18.52 (±0.63) years. The majority of subjects had an urban background (85%). Less than half had an exercise routine (44%) which was followed daily. As per body mass index (BMI) distribution, 19.57% were underweight, 11.3% were overweight and only 2.17% were obese. An unfavorable eating attitude was found in 18% of subjects whereas 38.2% had mild to the marked concern of body shape. There was a significant positive correlation between BSQ with BMI (r = 0.387, P ? 0.01) and BSQ-34 with EAT-26 (r = 0.367, P ? 0.01). Conclusion: Current study shows that late adolescent urban females are susceptible to eating disorders and are body image conscious. Institutional mechanisms should be brought in place to address the need of improving their eating habits and modification of lifestyle.
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Background: Airway management of patients with tracheal stenosis is highly challenging and even establishing a surgical airway may be difficult in these patients. Case: A 24 year old female developed pinhole tracheal restenosis after undergoing tracheal web resection and reconstruction. After other modes of ventilation had failed, we used the Manual jet ventilator endotracheal tube assembly as a rescue device and performed intermittent low-frequency jet ventilation until a definitive surgical airway could be established. Conclusion: Central airway obstruction in severe tracheal stenosis can cause life-threatening hypoxia. Jet ventilation through the pin hole opening buys some time for the surgeon to secure the airway.
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Purpose: To report the 1?year clinical outcomes related to safety, efficacy, predictability, contrast sensitivity, patient satisfaction, complications, and overall results with Optiflex Genesis and Eyecryl Plus (ASHFY 600) monofocal aspheric intraocular lenses (IOLs) and compare the same with Tecnis?1 monofocal IOL. Methods: This prospective, single?center, single?surgeon, randomized, three?arm study included 159 eyes of 140 eligible patients who underwent cataract extraction with IOL implantation with any of the three study lenses. Clinical outcomes related to safety, efficacy, predictability, contrast sensitivity, patient satisfaction, complications, and overall results were compared at a mean follow?up of 1 year (12 ± 1.20 months). Results: Preoperatively, age and baseline ocular parameters of all the three groups were matched. At 12 months post?op, no significant differences were noted among the groups in terms of mean postoperative uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively) sphere, cylinder, and spherical equivalent (SE; P > 0.05 for all parameters). Eighty?nine percent eyes in the Optiflex Genesis group as against 96% eyes in the Tecnis?1 and Eyecryl Plus (ASHFY 600) groups were within ± 0.5 D, and 100% of eyes in all the three groups were within ± 1.00 D of SE accuracy. Postoperative internal higher?order aberrations (HOAs) and coma, and mesopic contrast sensitivity at all spatial frequencies were comparable across all the three groups. Two eyes in the Tecnis?1 group, two eyes in the Optiflex group, and one eye in the Eyecryl Plus (ASHFY 600) group underwent YAG capsulotomy at the last follow?up. No eye in any of the groups showed glistenings or required IOL exchange due to any reason. Conclusion: At 1?year post?op, all the three aspheric lenses showed comparable results in visual and refractive parameters, post?op aberrations, contrast sensitivity, and posterior capsule opacification (PCO) behavior. Further follow?up is needed to evaluate the long?term behavior for refractive stability and PCO rates of these lenses. Trial registry: CTRI/2019/08/020754 (www.ctri.nic.in).
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Background: Primary dysmenorrhea (PD) affects adolescent girls within 2 years of menarche and roughly 16–91% suffer from it, heavily incapacitating their educational and social life. Elevated prostaglandins (PG’s), especially PGF2? is alleged to be the culprit behind PD but the prevalence continues to remain variable across various geographical domains. Aim and Objectives: The aim of the study was to ascertain the prevalence of PD and to determine the association between PD and body mass index (BMI). Materials and Methods: A cross-sectional study 250 randomly selected adolescent girls was conducted across different government and private schools of Hyderabad. The participants were asked to fill a self-administered questionnaire which included sociodemographic details, anthropometric measurements, and complete menstrual history including the prevalence and severity of PD. Participants were segregated into four groups according to the Revised IAP BMI charts and the intensity of pain was scored by Numerical Pain Rating Scale. Results: The prevalence of PD was estimated to be 70% with 34.7% complaining of severe PD. About 42.4% participants reported to suffer from PD, a day before menstrual flow and the most commonly associated symptoms were nausea and fatigue. About 52.68% participants suffered from PD every month. While assessing the impact of BMI on PD, the prevalence and severity of PD were found higher in overweight and obese participants and the difference was statistically significant. Lower age of menarche, longer cycles, and heavier flow were associated with increased risk of PD. Conclusion: PD is physically and emotionally challenging and as rising adolescent obesity is a correctible predisposing factor, there is an urgent need to acknowledge the issue.
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Justification: Anemia in children is a significant public health problem in our country. Comprehensive National Nutrition Survey 2016-18 provides evidence that more than 50% of childhood anemia is due to an underlying nutritional deficiency. The National Family Health Survey-5 has reported an increase in the prevalence of anemia in the under-five age group from 59% to 67.1% over the last 5 years. Clearly, the existing public health programs to decrease the prevalence of anemia have not shown the desired results. Hence, there is a need to develop nationally acceptable guidelines for the diagnosis, treatment and prevention of nutritional anemia. Objective: To review the available literature and collate evidence-based observations to formulate guidelines for diagnosis, treatment and prevention of nutritional anemia in children. Process: These guidelines have been developed by the experts from the Pediatric Hematology-Oncology Chapter and the Pediatric and Adolescent Nutrition (PAN) Society of the Indian Academy of Pediatrics (IAP). Key areas were identified as: epidemiology, nomenclature and definitions, etiology and diagnosis of iron deficiency anemia (IDA), treatment of IDA, etiology and diagnosis of vitamin B12 and/or folic acid deficiency, treatment of vitamin B12 and/or folic acid deficiency anemia and prevention of nutritional anemia. Each of these key areas were reviewed by at least 2 to 3 experts. Four virtual meetings were held in November, 2021 and all the key issues were deliberated upon. Based on review and inputs received during meetings, draft recommendations were prepared. After this, a writing group was constituted which prepared the draft guidelines. The draft was circulated and approved by all the expert group members. Recommendations: We recommend use of World Health Organization (WHO) cut-off hemoglobin levels to define anemia in children and adolescents. Most cases suspected to have IDA can be started on treatment based on a compatible history, physical examination and hemogram report. Serum ferritin assay is recommended for the confirmation of the diagnosis of IDA. Most cases of IDA can be managed with oral iron therapy using 2-3 mg/kg elemental iron daily. The presence of macro-ovalocytes and hypersegmented neutrophils, along with an elevated mean corpuscular volume (MCV), should raise the suspicion of underlying vitamin B12 (cobalamin) or folic acid deficiency. Estimation of serum vitamin B12 and folate level are advisable in children with macrocytic anemia prior to starting treatment. When serum vitamin B12 and folate levels are unavailable, patients should be treated using both drugs. Vitamin B12 should preferably be started 10-14 days ahead of oral folic acid to avoid precipitating neurological symptoms. Children with macrocytic anemia in whom a quick response to treatment is required, such as those with pancytopenia, severe anemia, developmental delay and infantile tremor syndrome, should be managed using parenteral vitamin B12. Children with vitamin B12 deficiency having mild or moderate anemia may be managed using oral vitamin B12 preparations. After completing therapy for nutritional anemia, all infants and children should be advised to continue prophylactic iron-folic acid (IFA) supplementation as prescribed under Anemia Mukt Bharat guidelines. For prevention of anemia, in addition to age-appropriate IFA prophylaxis, routine screening of infants for anemia at 9 months during immunization visit is recommended.
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Oral cavity is considered as one of important organ among precious supraclavicular organs. Its importance is very much due to its two important functions, one is eating and other one is speaking. Proper eating keeps healthy, energetic and providing strength to fight off sickness. Speaking allow us to communicate with others making us socially active. The ability to progress in life would be nearly impossible without both of these functions. To keep these proper, the oral cavity should be healthy. Oral health is a key indicator of overall general health, well-being and quality of life. Poor oral health can also lead to a slew of systemic problems later in life. It is reported, that diabetes mellitus is linked with the development and progression of periodontitis. As lack of oral care awareness and unhealthy food habits due to busy life, the prevalence of oral diseases is going on increase irrespective of age. Common among them are dental caries, periodontal diseases and even oral cancer. Most of the oral diseases are preventable. The progression of these diseases can also be arrested with change in diet and appropriate oral hygiene. Regarding oral health maintenance, Ayurveda recommends proper aahar vihar, some daily use procedures like dantdhavan, jihvanirlekhan, pratisaran, gandoosha and use of some single drugs decoction as mouth rinse. One can keep healthy oral cavity by following all these procedures.
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The Covid-19 pandemic brought a disastrous threat to the mankind and shook the fundamental assumptions of life to the core. The study aimed to assess the impact of the Covid-19 pandemic on the family members of covid positive patients in the first wave of virus transmission in India and the common notion towards vaccination. A qualitative research design was used to obtain the lived experiences of family members during the hospitalisation of the patients. The most positive outcome was observed on the environment, adopting healthy habits, and strengthening of personal bonding among family members. The policymakers can harness concerted efforts with adequate plans and policies for aiding in strong psychological support for people to combat the after-effects of the deadly virus along with real-time patient management. Information, education, and communication can be used to eliminate misconceptions regarding vaccination. The study further recommends making some online education programmes for the family members to enable them to combat the subsequent waves and new strains of virus.
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Background: There is limited literature in children on efficacy of different routes of vitamin B12 administration for vitamin B12 deficiency macrocytic-megaloblastic anemia. Objective: To compare parenteral with oral vitamin B12 therapy in children with macrocytic-megaloblastic anemia. Study design: Single-center, open-label randomized controlled trial. Participant: 80 children aged 2 month-18 year with clinical and laboratory features of nutritional macrocytic anemia. Intervention: All children received an initial single parenteral dose of 1000 µg vitamin B12 followed by randomization to either parenteral or oral vitamin B12 for subsequent doses. Group A was given 1000 µg intramuscular (IM) vitamin B12 (3 doses on alternate days for those aged <10 year, five doses for age >10 year), followed by monthly 1000 µg IM for the subsequent two doses. Group B was given daily oral vitamin B12 1500 µg (500 µg in <2 years age) for three months. Folic acid and iron supplementation, and relevant dietary advice were given to both groups in a similar fashion. Outcome: Improvement in serum vitamin B12 levels and total hemoglobin was compared three months post-treatment. Result: The median(IQR) increase in serum vitamin B12 level was significantly higher in group A [600 (389,775) vs 399 (313, 606) pg/mL; P= 0.016]. The median (IQR) rise of hemoglobin was also more in group A [2.7 (0.4,4.6) vs 0.5 (-0.1,1.2) g/dL; P=0.001]. Conclusion: Increase in serum vitamin B12 levels and hemoglobin was better in children with nutritional macrocytic anemia receiving parenteral as compared to oral vitamin B12.
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Annadrava shoola is one of the diseases of the alimentary canal in which there is colic occurs after digestion, during digestion or at any time and Patient feels relief after vomiting. It can be said gastric ulcer on the basis of its signs and symptoms. Gastric ulcers are most commonly located on the lesser curvature, whereas duodenal ulcers are most common at the duodenal bulb. The ulcer is round to oval with a smooth base. Acute ulcers have regular borders, while chronic ulcers have elevated borders with inflammation. An ulcer extends beyond the muscularis mucosa. Ayurveda encourages lifestyle interventions and natural therapies to regain a balance between the body, mind and the environment. In this paper, a case study on Annadrava shoola has been explained. A female patient of 42 years of age came to the Kayachikitsa OPD (OPD REG.no-6836) Government Ayurvedic College and Hospital, Patna-03 having complain of pain and burning sensation in abdomen for 5 months as well as irregular bowel evacuation (>3episode) in the last 3 months. The nature of pain was gradual on onset and burning type and exaggerated after meal. On the basis of history of the patient and endoscopy report, he was diagnosed as gastric ulcer and pan gastritis. We have done the Shamana Chikitsa for the patient. In Shamana Chikitsa was done with combinations of Sutashekhar Ras, Tab Aciloss and Shatavari Churna for one month. Endoscopy was repeated after one and half months of treatment. Report showed only that the treatment cured the Annadrava shoola (gastric ulcer) of the patient. So, there is hope in Ayurveda for the treatment of Annadrava shoola.
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Introduction: Enterobacterales that test resistant to at least one of the carbapenem antibiotics (ertapenem, meropenem, doripenem, or imipenem) are called Carbapenem resistant Enterobacterales (CRE) and if they produce a carbapenemase (an enzyme that can make them resistant to carbapenem antibiotics) they are called Carpenemase producing Enterobacterales (CPE). Children with CRE strains in fecal samples are considered as a high risk group by World Health Organization (WHO), which can spread CRE by intimate contact and travel. This cross-sectional study was conducted in the Departm Methods: ent of Microbiology, RIMS, Imphal, Manipur, India from Jan 2020 to Feb 2022. A total of 157 children under 2 years of age whose stool culture was positive for diarrhoeagenic Escherichia coli were included in the study. The modified carbapenem inactivation method (mCIM) has been done for detection of carbapenemase producers and the addition of EDTA in eCIM to further differentiate between serine and metallo-?-lactamase producers. Out of 157 Result and Discussion: Diarrhoegenic E.coli (DEC) ,Carbapenem resistance was seen in 9 isolates i.e 5.7 %. Out of these 9 isolates, 3 were MBL producers tested by the phenotypic test mCIM and eCIM. All the three MBL producers carried bla NDM-1 gene. mCIM/eCIM assay is designed to simultaneously detect and distinguish the different types of carbapenemases. Carbapenemase genes are often located on plasmids that can be exchanged between Enterobacteriaceae and other Gram-negative bacteria. Carbapenem-resistant K. pneumoniae are currently more frequent and more likely to cause healthcareassociated outbreaks, carbapenem-resistant E. coli pose a greater risk for spread in the community. Conclusion: Screening for carbapenemase producer using mCIM and eCIM essay is important along with infection control measure such as active surveillance through rectal screening for CRE carriage on hospital admission, contact precautions, hand hygiene, patient isolation, environmental sanitation, case notification/fiagging, antibiotic restriction.
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Background- Polycystic ovary syndrome (PCOS) is major endocrine and metabolic disease in reproductive women. As per latest procedures, letrozole should be taken as the first-line pharmacological treatment for infertile women with PCOS. This study was planned to study the role of clinical profile in ovulation induction after letrozole therapy among infertile women with polycystic ovarian syndrome. This was a prospective analytical observational st Methods- udy carried out at the IVF centre, SMS Medical College, Jaipur. The present study enrolled 100 patients attending the IVF centre for fertility treatment who were diagnosed with PCOS as per Rotterdam criteria. Anthropometric measurements like Body mass index (BMI calculated as weight in kilograms divided by square of height in meters) and waist circumference (the smallest circumference at the level of umbilicus) was taken. A comprehensive physical examination of all patients was done to note signs of clinical hyperandrogenism like acne, alopecia, and hirsutism. Treatment response was defined as ovulation in response to letrozole in doses from 2.5 mg to 7.5 mg. In this study, women from 20 to 25 years of age w Results- ith shorter duration of infertility, lower BMI, lower waist circumference, absence of hirsutism, or mild hirsutism on clinical examination showed better response to Letrozole. ConclusionLetrozole can be considered a suitable ovulation induction agent in infertile PCOS patients with lower BMI, lower waist circumference, and absence of hirsutism. A predictive ovulation score can be developed from basic clinical parameters. Identification of various factors affecting response to letrozole may help the clinician to individualize ovulation induction protocols in PCOS women.
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Background & Aims: The coronavirus pandemic has caused a rapid surge in patients requiring intensive care unit (ICU) admission. The mainstay of treatment is supplemental oxygen therapy by an oxygen mask, nonrebreathing mask, high flow nasal oxygen therapy (HFNOT), non-invasive and invasive mechanical ventilation. HFNOT is a relatively newer, easy-to-use technique with better patient compliance. This study aimed to assess the outcome of HFNOT in Corona Virus disease (COVID) patients in ICU. Methods: This record based; retrospective study included 43 reverse transcriptase polymerase chain reaction (RTPCR) confirmed COVID patients whose respiratory support was initiated on HFNOT as per the inclusion criteria. The primary outcome of this study was to assess the number of patients requiring mechanical ventilation (HFNOT failure). The secondary outcome was to assess the association of HFNOT failure with age, co-morbidity index, and severity of illness. Results: Out of forty-three patients, twenty-five patients (58%) required conversion to mechanical ventilation. Eighteen patients (42%) were managed with HFNOT alone. HFNOT failure was more with increasing age and higher comorbidity score (p value<0.05). Conclusion: We concluded that HFNOT can be successfully used in COVID patients in ICU without the need for mechanical ventilation. However, it should be used cautiously in patients with higher 4C mortality scores.
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Background: Acute corneal hydrops is a vision threatening complication of corneal ectasia like keratoconus, keratoconus, keratoglobus, Pellucid marginal degeneration, Terrien’s marginal degeneration and post refractive surgery keratectasia. The associated risk factors for development of corneal hydrops (CH) are early onset of keratoconus, microtrauma associated with contact lens use, eye rubbing, allergic conjunctivitis, atopy, and Down’s syndrome. With the conservative approach of management of CH, it takes longer time (in months) for corneal oedema to get resolved and there is development of vascularization and scarring. This video presents the simple technique of using compression sutures along with pneumodescemetopexy by intracameral air injection for management of CH. It led to rapid resolution of corneal oedema. It is a simple technique, with no need of special gases like C3F8 or SF6 and can be easily performed at a very basic set up. Purpose: To highlight the efficacy of simple technique of applying compression sutures and air tamponade in management of CH and to demonstrate the efficacy of anterior segment OCT in diagnosis and to assess the prognosis of a case of CH. Synopsis: A 9-year-old boy presented with CH, with anterior segment OCT showing torn descemet’s membrane and fluid pockets in corneal stroma. Four full-thickness compression sutures were applied and intracameral sterile air was used for pneumodescetopexy. The serial post operative clinical and OCT picture showed rapid resolution of corneal oedema. Highlights: This video highlights the use of OCT imaging in the diagnosis of CH and full-thickness compression sutures as the safe and effective technique in the management of acute CH.
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Introduction: Induction of labour is the artificial initiation of labour before its spontaneous onset for the purpose of delivery of the foetoplacental unit. The purpose of this study was to determine whether the current practice of elective labour induction was associated with differences in mode of delivery, demand for pain relief and foetal outcomes when compared with labour of spontaneous onset. Methods And Materials: This cross-sectional study carried out on 100 pregnant women with singleton pregnancy between 37 and 41 weeks of gestation with cephalic presentation delivering in labour room. This study included two groups: Electively induced (50) and spontaneous group (50). Results: In electively induced group 44% had normal vaginal delivery and 6% had instrumental delivery. With spontaneous labour, 78% had normal vaginal delivery and 4% had instrumental delivery. Postpartum hemorrhage (PPH) was 20% in electively induced group and 6% in the spontaneous group (p-0.038).Apgar scores, mean birth weights were comparable. Analgesia demand was 22% in the electively induced group when compared to 6% in the spontaneous group. Conclusion: The present study emphasizes that elective induction of labour in nulliparous women with a single cephalic presentation is associated with increased risk of caesarean section, which is predominantly related to an unfavorable cervix. Hence, elective induction is safe and efficacious. Caesarean delivery rate was more due to nulliparity or unfavorable cervix not due to elective induction itself.
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Mushrooms have been dietary source in hilly and ethnic tribes of India. More than 5000 mushroom species are known worldwide and nearly 100 species are known to be poisonous for humans. Mushroom poisoning occurs due to unintentional and accidental ingestionof poisonous mushroom due to misidentification of poisonous variety as edible one. There has been increasingly incidence of reporting of mushroom poisoning cases nowadays. Here we are reporting case series of 4 patients admitted hailing from same village with accidental ingestion of poisonous mushrooms with clinical-laboratory profile and outcome at our institution. Mushroom Poisoning is an emerging healthcare concern nowadays. Education and mass awareness for identification of poisonous mushrooms is an important preventive measure. Early hospitalization, proper hydration, gastric decontamination, silibinin and N-acetyl cysteine therapy with hepato-renal support constitutes mainstay of treatment. Delay in treatment and complications results in poor prognosis and mortality.